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The Center for Medicare and Medicaid Services (CMS) announced March 23 that it will begin covering the cost of U.S. Food and Drug Administration (FDA)–approved facial wasting (lipoatrophy) treatments for Medicare beneficiaries who have facial lipoatrophy caused by antiretroviral drug use. Effective immediately, CMS will begin covering the cost of facial fillers for people living with HIV who are experiencing symptoms of depression related to the stigmatizing effects of lipoatrophy.

Lipoatrophy is a condition where fat just beneath the skin is lost over time. Lipoatrophy is a side effect caused primarily by the antiretroviral drugs Zerit (stavudine) and Retrovir (zidovudine). Though lipoatrophy can affect any part of the body, it is particularly noticeable and most often stigmatizing when it involves the face.

There are two temporary facial fillers for lipoatrophy: Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite). Both cost about $1,500 per application, and people may require treatment more than once per year, a recurrent expense many people with HIV cannot afford.

One of the documented consequences from facial lipoatrophy is depression, brought on because of the stigmatizing nature of facial fat loss. Several studies have shown that treating facial lipoatrophy reduces depressive symptoms in people with HIV.

CMS’s decision “marks an important milestone in Medicare’s coverage for HIV-infection therapies,” said the agency’s chief medical officer and director of its clinical standards and quality. “Helping people living with HIV improve their self-image and comply with anti-HIV treatment can lead to better quality of life and, ultimately, improve the quality of care that beneficiaries receive.”

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